Bending the Elbow and Conventional Exercise Prolong Life Download Complimentary

By John Gever
COPENHAGEN, Jan. 8 -- Exercise and moderate alcohol intake were correlated with lower death rates over a 20-year period, researchers here found.

People who consumed from one to 14 alcoholic beverages a week had 20-year death rates from ischemic heart disease about 30% lower than did non-drinkers across all levels of physical activity, reported Morten Grønbæk, M.D., Ph.D., of the University of Southern Denmark, and colleagues in the online European Heart Journal.

It's the latest study to find, as the researchers put it, "adverse health effects associated with alcohol abstention." Action Points
--------------------------------------------------------------------------------

Explain that the study found that exercise and drinking alcohol in moderation were correlated with lower death rates.


Point out that the study was not controlled and hence it did not prove causality.
Exercise had a less pronounced effect on cardiac death rates, although it was significantly protective in terms of all-cause mortality.


However, "neither physical activity alone nor alcohol intake can completely reverse the increased risk associated with physical inactivity and alcohol abstention," the researchers concluded.


They based their findings on approximately 20 years of follow-up health data on 11,914 participants in the Copenhagen City Heart Study. From 1981 through 1983, these individuals had undergone physical exams and filled out questionnaires on their leisure-time physical activity, alcohol consumption, and other health-related issues. Those with existing heart disease at that time were excluded. Their subsequent medical history was obtained from Danish national health records.


During the follow-up period, 1,242 participants died of ischemic heart disease and 5,901 died overall.


The researchers stratified participants into three groups for alcohol consumption. Non-drinkers were those imbibing less than one drink a week, moderate drinkers were those taking one to 14 drinks weekly, and heavy drinkers were those consuming more than 15 drinks a week.


The investigators also defined three levels of activity: inactive (less than two hours of light exercise weekly), low activity (two to four hours of light exercise), and moderate/high activity (more than four hours of light exercise or two to four hours of vigorous exercise).


In terms of death from ischemic heart disease, the investigators found that non-drinkers fared worse than moderate drinkers across all levels of physical activity.


They calculated the following hazard ratios relative to moderate drinkers, adjusted for age, smoking status, body mass index, education, marital status, and diabetes:


1.30 (95% CI: 1.04 to 1.63) among physically inactive non-drinkers
1.31 (95% CI: 1.08 to 1.59) among non-drinkers with low activity
1.30 (95% CI: 1.04 to 1.63) among non-drinkers with moderate or high activity

Looking only at moderate drinkers, activity level did not significantly alter heart disease death rates, the researchers found. The same was true among heavy drinkers.


Only for non-drinkers did exercise appear to have a protective effect, with low and moderate-high activity associated with hazard ratios for heart disease death of 0.68 to 0.71 relative to sedentary non-drinkers.


On the other hand, the researchers said, "being both physically active and drinking at least one drink weekly was associated with a 44% to 50% lower hazard ratio of fatal ischemic heart disease" compared with inactive non-drinkers.


For all-cause mortality, exercise had more of a protective effect than alcohol intake. Death rates were similar among the physically inactive for all levels of drinking. The lowest hazard ratios for all-cause mortality, relative to the physically inactive non-drinkers, were in moderate drinkers who engaged in low or moderate/high activity (HR: 0.70, 95% CI: 0.60 to 0.75).


Non-drinkers who claimed at least two hours of weekly activity also suffered lower all-cause mortality than did physically inactive moderate drinkers.


Risks among heavy drinkers were similar to those in non-drinkers for all-cause mortality but not for heart disease deaths. Deaths from heart disease were not significantly more frequent among physically inactive heavy drinkers than any other group in the study.


Statistical analysis indicated that levels of high-density lipoprotein (HDL) cholesterol were also a significant factor in the results, the researchers said. They calculated that HDL levels mediated 29% to 58% of the effect of alcohol consumption on fatal heart disease in men. In women, HDL accounted for 15% to 32% of the effect.


There was no interaction of HDL levels with physical activity, the researchers said.


The study had a number of limitations. The authors mentioned the unknown degree of heterogeneity among the non-drinkers as a limitation of the study. "The group of non-drinkers is a mixture of never drinkers and rare drinkers and may also be a mixture of former heavy drinkers, drinkers who underreport, and people who are ill and therefore have stopped drinking," they noted.


Diet was not a factor assessed in the study and the authors stated that increased physical activity and moderate drinking may have been associated with a healthier diet. It's also possible that some participants had undiagnosed heart disease at baseline, the researchers said.


Timothy Church, M.D., Ph.D., M.P.H., a preventive medicine specialist at Louisiana State University, commented that the study "reinforces a lot of stuff we already know" about exercise and alcohol consumption.


He said he was impressed with the quality of data the Danish researchers had assembled, especially about alcohol consumption, strengthening their conclusions.


Dr. Church said it is now well established that, among the undifferentiated adult population, "moderate levels of drinking provide health benefits."


He said the main obstacle to a forthright recommendation that teetotalers start drinking is the inability to identify those who may develop drinking problems as a result.


Future research should focus on high-risk groups such as people with diabetes or a history of heart disease, he recommended.



The study was funded by the Danish Heart Foundation.
Additional source: European Heart Journal
Source reference:
Pedersen J, "The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischemic heart disease and all-cause mortality" European Heart Journal 2008; DOI: 10.1093/eurheartj/ehm574.